MEDICARE: KARLA DANIELA DOUGLAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	1029525	TX

General Provider Information

NPI Number	:	1871185033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA DANIELA DOUGLAS

Provider Business Mailing Address
First Line	:	1432 WESTVIEW LN
Second Line	:
City	:	NORTHLAKE
State	:	TX
Zip	:	76226-1466
Country	:	US
Telephone Number	:	940-230-8130
Fax Number	:

Provider Business Practice Location Address
First Line	:	9701 HARMON RD STE 141
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76177-7602
Country	:	US
Telephone Number	:	817-306-5630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	07/27/2023

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Directions to “ KARLA DANIELA DOUGLAS ” Practice Location

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